Links T P, van Tol K M, Jager P L, Plukker J Th M, Piers D A, Boezen H M, Dullaart R P F, de Vries E G E, Sluiter W J
Department of Endocrinology, University Hospital Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
Endocr Relat Cancer. 2005 Jun;12(2):273-80. doi: 10.1677/erc.1.00892.
In differentiated thyroid carcinoma 10-year survival rates amount to 80-95%. Because age at diagnosis varies widely, these survival rates strongly depend on age at presentation. The aim of the present study was to analyse the attributable risk factors, including therapy per se, on survival in thyroid cancer after proper adjustment for the baseline mortality rate in the general population and to elucidate the adverse treatment effects on survival. Initial treatment in 504 patients consisted of thyroidectomy and 131I ablation. High-dose 131I was administered for residual disease. Patients in complete remission underwent an annual physical examination and thyroglobulin measurements during TSH suppression. Survival time was studied after transformation to standardised survival time to adjust for the baseline mortality rate in the general population. Median follow-up since diagnosis was 9 years. The 10-year overall survival was 83% and disease-specific survival 91%. After initial treatment, persistent disease occurred in 75 patients (15%). In univariate analysis, T4, N1, M1 status and Hürthle cell type were prognostic for persistent and recurrent disease. Age was not prognostic for recurrent disease in multivariate analysis. The standardised survival time was not altered in disease-free patients. However, patients with persistent disease had a median standardised survival time of only 0.60 (95% confidence interval 0.47;0.72), ranging from 0 to above 1, independent of initial tumour status or age. The cumulative proportion of persistent disease was at least 20% of the whole group. Disease-free patients after thyroid carcinoma have a normal residual life span. In contrast, in cases of persistent disease the life expectancy ranges widely with its median being reduced to 60%. Overall, treatment including radioiodine is safe but unsuccessful in 20% of the patients. Age is not a disease-specific risk factor and should not be used as an independent factor in treatment algorithms.
分化型甲状腺癌的10年生存率为80% - 95%。由于诊断时的年龄差异很大，这些生存率很大程度上取决于就诊时的年龄。本研究的目的是在适当调整一般人群的基线死亡率后，分析包括治疗本身在内的甲状腺癌生存的归因风险因素，并阐明治疗对生存的不良影响。504例患者的初始治疗包括甲状腺切除术和131I消融。对残留病灶给予高剂量131I治疗。完全缓解的患者在促甲状腺激素抑制期间每年进行体格检查和甲状腺球蛋白测量。在将生存时间转换为标准化生存时间以调整一般人群的基线死亡率后，对生存时间进行了研究。自诊断以来的中位随访时间为9年。10年总生存率为83%，疾病特异性生存率为91%。初始治疗后，75例患者（15%）出现持续性疾病。单因素分析中，T4、N1、M1状态和许特耳细胞类型是持续性和复发性疾病的预后因素。多因素分析中，年龄不是复发性疾病的预后因素。无病患者的标准化生存时间没有改变。然而，持续性疾病患者的标准化生存时间中位数仅为0.60（95%置信区间0.47；0.72），范围从0到1以上，与初始肿瘤状态或年龄无关。持续性疾病的累积比例至少占整个组的20%。甲状腺癌后无病患者的剩余寿命正常。相比之下，在持续性疾病的情况下，预期寿命差异很大，中位数降至60%。总体而言，包括放射性碘在内的治疗是安全的，但20%的患者治疗失败。年龄不是疾病特异性风险因素，不应在治疗算法中用作独立因素。
